Method and apparatus for treating gas for use in endoscopic surgery

ABSTRACT

An apparatus for conditioning gas for use in a medical procedure, such as endoscopy, the gas being received into the apparatus from a gas source. The apparatus comprises a housing defining a chamber having an entry port and an exit port. A humidification means comprising at least one water-retainer layer is disposed within the chamber in the path of travel of the gas for humidifying the gas as it passes through the chamber. A humidity sensor is disposed within the chamber that senses the humidity of the gas exiting the chamber. A monitoring circuit is connected to the humidity sensor that detects when the chamber requires a recharge of liquid based on the humidity of the gas in the chamber, and generates a recharge signal indicative thereof. A charging port on the housing provides access into the chamber to recharge the chamber with water. A heating element and temperature sensor are also disposed within the chamber. A control circuit further regulates the temperature of the gas exiting the chamber.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation of application Ser. No. 09/497,620; filed Feb. 3,2000, now U.S. Pat. No. 7,066,902 which is a divisional application ofSer. No. 09/081,186; filed May 19, 1998 now U.S. Pat. No. 6,068,609. Thepriority of application Ser. Nos. 09/497,620 and 09/081,186 arespecifically claimed, and they are incorporated herein by reference, intheir entireties. Application Ser. No. 09/497,620; filed Feb. 3, 2000,is pending as of the filing date of the present application.

BACKGROUND OF THE INVENTION

1. Field of Invention

This invention relates to conditioning gases used to inflate bodycavities prior to and during medical procedures. More specifically, itrelates to a compact device for, and method of, heating, humidifying andfiltering insulation and other gases.

2. Description of the Related Art

From the beginning of laparoscopic surgical procedures some thirty yearsago, it has been assumed that the condition of gases used to inflatebody cavities and spaces were physiologically and pathologically benign.While the importance and use of temperature and moisture conditioning ofanesthesia gases has been well known, until recently little attentionhad been given to the particulate, temperature and/or humidity conditionof insufflation gases used to create a pneumoperitoneum. Reduction incore body temperature, introduction of foreign bodies and drying ofsurfaces (including peritoneal surfaces), resulting from theintroduction of insufflation gases in such surgical procedures arecontinuing problems.

A commonly used insufflation gas is carbon dioxide which is typicallyprovided as a liquid in compressed gas cylinders. The pressure in thesecylinders, when at equilibrium with ambient environment of 20° C., is 57atmospheres (5740 kPa). The carbon dioxide gas is typically provided tothe surgical site at a pressure of 15 mmHg via an adjustable, throttlingpressure regulator and flow controller called an insufflator. Manymodels of insufflators are available such as the Storz Model 26012 (KarlStorz Endoscopy-America Inc., Culver City, Calif.). In general,Insufflators do not filter, few have the capability to control the gastemperature, and none are known to have the capability of humidifyingthe gas.

It is known to filter insufflation gas to prevent inorganic particlessuch as metallic fillings or particles, rust, dust, and polymerparticles from passing into the pneumoperitoneum (see, e.g., Ott, D. E.,J. Gynecol. Surg., 5:205-208 (1989)). The location and type of filter,however, are very important factors which will influence theeffectiveness of the method. Filters having a pore size as small as 0.2microns have been used in previous insufflation systems. These devices,however, utilize a filter material that is typically hydrophilic andwhen it becomes moist, loses its strength and some of its filteringeffectiveness. Moreover, because these prior art filter devices are nothydrophobic, they lose their filtering capability by tearing under thewater pressure caused by accidentally suctioning or siphoning peritonealor irrigation fluids.

In addition, in order to compensate for the cool temperature and drynessof the carbon dioxide insufflation gas, an apparatus and method havebeen developed to control the temperature and humidity of theinsufflation gas as it is delivered into the body. Such an apparatus andmethod are disclosed in commonly assigned U.S. Pat. No. 5,411,474 toOtt, et al., the entirety of which is herein incorporated by reference.Nevertheless, there is room for improvement of a heating, hydrating andfiltering apparatus for the delivery of insufflation gases.

SUMMARY OF THE INVENTION

The present invention is directed to an apparatus and method forproviding heated and humidified gas to a patient such that heat loss intransfer of the gas is minimized, and such that humidity of the gas ismonitored and the temperature of the gas is controlled throughout theprocedure.

Briefly, the present invention is directed to an apparatus forconditioning gas for use in a medical procedure, such as endoscopy, thegas being received into the apparatus from a gas source, such as aninsufflator. The apparatus comprises a heater/hydrator having a housingthat defines a chamber in which a humidification means and a heatingmeans are disposed in the flow path of the gas through the chamber. Thehumidification means comprises at least one liquid-retainer layercapable of absorbing a liquid, such as water, supplied into the chamberfor humidifying the gas as it travels through the chamber. The heatingmeans comprises a heating element disposed in the chamber preferablybetween the liquid-retaining layers. A humidity sensor is provided inthe chamber that senses the humidity of the gas in the chamber and atemperature sensor is provided in the chamber to detect the temperatureof the gas. A charging port on the housing provides access into thechamber to recharge the chamber with liquid. A monitoring circuit isconnected to the humidity sensor that monitors the humidity of the gasexiting the chamber and particularly detects when the chamber requires arecharge of liquid based on the humidity of the gas in the chamber, andgenerates a recharge signal indicative thereof. An audible and/or visualalarm device may be activated in response to the recharge signal. Acontrol circuit controls electrical power supplied to the heatingelement to regulate the temperature of the gas exiting the chamber.

Moreover, the present invention relates to a method of providing, forany selected period of time, heated and humidified gas into a patientfor a medical procedure comprising the steps of directing a gas from agas source into a chamber; humidifying the gas within the chamber with avolume of liquid; sensing the humidity of the gas as it exits thechamber; and monitoring the humidity of the gas exiting the chamber. Thegas from the gas source may be pressure and/or volumetricallycontrolled.

The above and other objects and advantages of the present invention willbecome more readily apparent when reference is made to the followingdescription taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic view of an apparatus according to the presentinvention.

FIG. 2 is a cross-sectional view of the heater/hydrator of the apparatusaccording to the present invention.

FIG. 3 is a schematic diagram of a heating element used in theheater/hydrator.

FIG. 4 is a cross-sectional view of the heater/hydrator chamber andshowing the fluted gas inlet and outlet of the chamber.

FIG. 5 is a schematic diagram showing the control circuit forcontrolling the temperature of the gas and for detecting when thehumidity of gas is below a predetermined humidity level.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention is directed to a method and apparatus for heatingand hydrating gas, wherein the humidity of the gas is monitored and theuser is informed when the humidity of the gas exiting the apparatusdrops below a predetermined threshold. The method and apparatus furtherprovides a means to “recharge” the heater/hydrator with liquid, allowinguse of the apparatus for an indefinite period of time. Thus, theapparatus can be used for any endoscopic or other procedure, regardlessof its length and regardless of unexpected time delays during theprocedure.

As used in the claims, “a” can mean one or more.

As used herein, “a predetermined temperature” is one that has beenpreset and is not altered during a procedure. For laparoscopicprocedures, the desirable predetermined temperature is typicallyphysiological body temperature, i.e., approximately 35 to 45° C.

As used herein, the term “liquid” means water (preferably sterile) or acombination of water and other substances, such as drugs or anesthetics,or a gel substance containing water and other substances.

As used herein, any apparatus “immediately adjacent” to a patient or anobject indicates a position sufficiently physically close in proximityto the patient or object such that gas at a temperature in the apparatuswill not lose more than 2° C. while traveling from the apparatus to theinterior of the patient or object. Such a distance would be, forexample, from about 0 to 10 inches, preferably from 0 to 10 cm, and morepreferably from 0 to 3 cm.

Referring to FIG. 1, the apparatus for treating or conditioninginsufflation gas is shown generally at reference numeral 100. Theapparatus 100 is adapted to receive gas from a gas source (high or lowpressure, high of low flow rate), such as insufflation gas from aninsufflator 10 for delivery into a body of a patient. The apparatuscomprises a filter 110, a heater/hydrator 120, and a control module 140.A tubing set is provided to connect the various components of theapparatus together. Specifically, a first tube segment 160 connects theoutlet of the insufflator 10 to the inlet tubing of the filter 110 via amale Luer lock 166 or any appropriate adapter compatible with theinsufflator outlet port. A second tube segment 162 connects the outletof the filter 110 to the inlet of the heater/hydrator 120. A third tubesegment 164 connects the outlet of the heater/hydrator 120 by a maleLuer lock 168 (or other appropriate fitting adapter) to a gas deliverydevice (not shown), such as a trocar, verres needle, endoscope or a tubethat enters a body cavity or space that delivers the filtered, heatedand humidified gas into the body of a patient. The tubing of the tubesegments 160, 162 and 164 is preferably flexible and sufficiently longto permit the insufflator 10 and control module 140 to be placed at aconvenient distance from a patient undergoing laparoscopic or othersurgery or procedure requiring gas distention, while the heater/hydrator120 is preferably placed immediately adjacent to the patient.

The filter 110 is an optional element and consists of a high efficiency,hydrophobic filter (for example Gelman Sciences Metricel M5PU025) havinga pore size preferably small enough to exclude all solid particles andbacterial or fungal agents that may have been generated in a gas supplycylinder or the insufflator 10 (i.e., 0.5 micron or less and preferablyabout 0.3 micron). A preferable filter is a hydrophobic filter, such asa glass fiber-type filter, e.g., Metrigard (Gelman Sciences or PorousMedia Ultraphobic filter DDDF 4700 M02K-GB). Other suitable filtersinclude polysulfone (Supor, HT Tuffrin, Gelman Sciences) and mixedcellulose esters (GN-6 Metricel, Gelman Sciences), for example.Decreasing the pore size of filter 110 below 0.3 micron causes aconcomitant increase in pressure drop of gas, and thus flow rate isreduced significantly. If the medical procedure to be performed requiresa relatively high pressure and/or flow rate of gas to the patient, suchas laparoscopy, the pore size should preferably not decrease below 0.3micron. A hydrophobic filter is preferable to a hydrophilic one, as ahydrophobic filter is less likely to tear under water pressure caused byaccidentally suctioning or siphoning peritoneal or irrigation fluids.

In one embodiment, the heater/hydrator 120 is connected immediatelyadjacent to a gas delivery device so that the gas travels a minimumdistance from the outlet of the heater/hydrator 120 to the conduit orconnection to the interior of a patient. The purpose of this arrangementis to allow gas to be delivered to the patient while still at atemperature and water content sufficiently close to the physiologicalinterior body temperature. That is, the apparatus according to theinvention prevents thermodynamic cooling of medical gases in transit tothe patient, because it provides a highly efficient heating andhumidifying chamber that, as a result of its efficiency, can be quitecompact and thus be positioned very near to the patient.

The control module 140 is contained within an electrical housing 210 andis connected to the heater/hydrator 120 by several wire pairs containedwithin an insulated electrical cable 170. In particular, the cable 170has a connector 172 at one end that electrically connects into areceptacle of the housing 210 for the control module 140, and at theother end it is electrically connected to the heater/hydrator 120 by asealed electrical feedthrough 174. The cable 170 is attached to the tubesegment 162 by a plastic tape or clip 176. Alternatively, the cable 170is attached to the tube segment 162 by heat seal, extrusion, ultrasonicwelding, glue or is passed through the interior of tube segment 162.

The control module 140 and associated components in the heater/hydrator120 are preferably powered by an AC-DC converter 180. The AC-DCconverter 180 has an output that is connected by a plug connector 182into a receptacle of the housing 210 to the control module 140, and hasa standard AC wall outlet plug 184 that can be plugged into standard ACpower outlets. For example, the AC-DC converter 180 is plugged into anAC power strip that is provided on other equipment in an operating room.Alternatively, electrical power for the apparatus is provided by abattery or photovoltaic source. Another alternative is to providecircuitry in the control module 140 that operates on AC signals, asopposed to DC signals, in which case the control module 140 could bepowered directly by an AC outlet.

The heater/hydrator 120 has a charging port 190 that is capable ofreceiving a supply of liquid therethrough to charge the humidificationmeans (described hereinafter) with liquid. For example, a syringe 200containing a predetermined volume of liquid is introduced into thecharging port 190 to inject liquid into the heater/hydrator 120 for aninitial charge or re-charge of liquid. The apparatus 100 may be soldwith the heater/hydrator 120 pre-charged with a supply of liquid suchthat an initial charge is not required for operation.

Turning to FIG. 2, the heater/hydrator 120 will be described in greaterdetail. The heater/hydrator 120 comprises a housing 122 having an (entryport) inlet 124 and an (exit port) outlet 126. The housing 122 defines achamber 128 that contains elements for substantially simultaneouslyheating and hydrating (humidifying) the gas supplied through the inlet124, as well as means for sensing the temperature of the gas and therelative humidity of the gas as it exits the chamber 128.

Specifically, within the chamber 128, there is provided humidificationmeans preferably comprised of one or more layers of liquid-retaining orabsorbing padding or sponge material, shown at reference numerals 130,131 and 132. It should be understood that the number, spacing andabsorbency of the liquid-retaining layers 130, 131 and 132 may be variedaccording to specific applications. Three liquid-retaining layers areshown as an example. The material of the liquid-retaining layers 130,131 and 132 can be any desirable liquid-retaining material, such as aborosilicate-type material (e.g., a rayon/polyester formed fabric,called NU GAUZE™, manufactured and sold by Johnson & Johnson Medical,Inc.). The pore size of the selected material should be chosen accordingto a balance of water retention capabilities and low pressure dropconsiderations. The larger the pore size, the greater the waterretention capability for humidification.

Other forms of the humidification means may consist of a chamber ofliquid (without liquid-retaining layers) having semi-permeable membraneon opposite ends to allow gas to pass therethrough. The liquid in thechamber could be heated by a heating jacket placed around the chamber tothereby heat and humidify the gas passed therethrough.

The heating means in the heater/hydrator 120 consists of at least oneheating element 134 positioned in the housing (substantially) co-locatedwith the humidification means, such as between the liquid-retaininglayers 130 and 131. The heating element 134 is an electrically resistivewire, for example, and is described in more detail hereinafter inconjunction with FIG. 3. The heating element 134 is positioned withinthe humidification means insofar as it is placed preferably betweenliquid-retaining layers. The heating element 134 heats the insufflationgas supplied through the inlet, under control of a heat control signalsupplied by the control module 140, substantially simultaneous with thehumidification of the gas as the gas passes through the chamber 128.Additional heating elements may be disposed within the chamber.

In order to sense the temperature and humidity of the gas as it exitsthe heater/hydrator 120, a temperature sensor 136 and a relativehumidity sensor 138 are provided. The temperature sensor 136 may beprovided anywhere within the flow of gas in the chamber 128, but ispreferably positioned on the downstream side of the heating element 134between liquid-retaining layers. The temperature sensor 136 is athermistor (for example, Thermometrics Series BR23, Thermometrics, Inc.,Edison, N.J.). It is preferable that the temperature sensor 136 beaccurate to within about 0.2° C. In the present invention, thetemperature of the gas is preferably sensed after the gas has beenhumidified so that any change in the temperature of the gas as it ishumidified is corrected at that point in the apparatus, therebycompensating for enthalpy changes.

The humidity sensor 138 is positioned in the flow path of gas exitingthe chamber 128, preferably downstream from the heating element 134either between liquid-retaining layers or on the downstream side of theliquid-retaining layers, proximate the exit port 126 of the housing 122.The humidity sensor 138 is preferably not in contact with aliquid-retaining layer. FIG. 2 shows the humidity sensor 138 distal tothe liquid-retaining layers, separated from the liquid-retaining layer132 by a porous mesh (plastic or metal) layer 133 that extends acrossthe interior of the housing 122. The humidity sensor 138 actually isgenerally not in contact the porous mesh layer 133, but is spacedtherefrom as well. The humidity sensor 138 is a humidity-sensitivecapacitor sensor, such as a capacitive humidity sensor manufactured byPhilips Corporation, which changes capacitance in response to humiditychanges. The humidity sensor 138 measures the relative humidity of thegas as it passes through the chamber 128 to enable monitoring of the gashumidity, and in order to provide an indication of the amount of liquidremaining in the humidification means, i.e., in liquid-retainer layers130, 131 and 132. As will be explained hereinafter, a timer/dividerintegrated circuit (IC) 145 (FIG. 5), is connected to the humiditysensor 138 and is preferably disposed within the housing 122 togetherand substantially co-located with the humidity sensor 138.

Electrical connections to the components inside the housing 122 of theheater/hydrator 120 are as follows. A ground or reference lead (notspecifically shown) is provided that is connected to each of thetemperature sensor 136, heating element 134 and humidity sensor 138timer/divider 145. A wire 175 (for a positive lead) electricallyconnects to the heating element 134 and a wire 176 (for a positive lead)electrically connects to the temperature sensor 136. In addition, threewires 177A, 177B and 177C (shown in more detail in FIG. 5) electricallyconnect to the humidity sensor 138 timer/divider circuitry, wherein wire177A carries a DC voltage to the timer/divider 145, wire 177B carries anenable signal to the timer/divider 145, and wire 177C carries an outputsignal (data) from the timer/divider 145. All of the wires are fed fromthe insulated cable 170 into the feedthrough 174 and through small holesin the housing 122 into the chamber 128. The feedthrough 174 is sealedat the opening 178 around the cable 170. The charging port 190 isattached to a lateral extension 139 of the housing 122. The chargingport 190 comprises a cylindrical body 192 containing a resealable member194. The resealable member 194 permits a syringe or similar device to beinserted therethrough, but seals around the exterior of the syringe tip.This allows a volume of liquid (sterile water, etc.) to be deliveredinto the chamber 128 without releasing the liquid already containedtherein. The resealable member 194 is, for example, Baxter InterLink™injection site 2N3379. Alternatively, the charging port may be embodiedby a one-way valve, a sealable port, a screw cap, a cap with a slit topermit the introduction of a syringe or other device, such as aSafeline™ injection site, part number NF9100, manufactured by B. BraunMedical Inc., or any other covering material or member capable ofpermitting the introduction of a syringe and preventing the backflow ofcontained liquid or gas. The chamber 128 will contain approximately 3 to8 cubic centimeters (cc) (but possibly as much as 10 cc) of liquid, andit is desirable that the gas have a dwell time within the chamber of atleast approximately 0.01 to 1.0 sec. A liquid volume of 8 cc in thechamber 128 will usually be adequate for conditioning approximately 180liters of insufflation gas at a desirable relative humidity of 80-95%.The control module 140, however, will issue a warning when the humidityof the gas being treated by the heater/hydrator 120 drops below apredetermined relative humidity, as explained hereinafter.

The housing 122 preferably has a length to width ratio of about 1:2 toabout 1:10, with a more preferable ratio of about 1:3 to about 1:4.Typically, the length of the housing 122 is from about 0.5 cm to about1.5 cm, and the diameter can be about 3.0 cm to about 5.0 cm. Forexample, a preferable housing 122 is approximately 3.5 centimeters (cm)in diameter and 1.0 cm thick. The length and width of chamber 128 can bevaried such that proper heating and humidification occur. An elongatedhousing configuration would permit the heater/hydrator 120 to be lessintrusive to the medical attendant or surgeon and also be freely movablewith respect to other equipment in or around the apparatus 100.

The desirable width and diameter of the chamber is also dependent uponthe rate of gas flow from insufflator 10, which is usually from about1-10 liters/minute, and upon the pressure desired to be maintained,which is affected more by the diameter of chamber 128 than by itslength. A person of ordinary skill in the art, given the teachings andexamples herein, can readily determine suitable dimensions for chamber128 without undue experimentation. It should also be noted, however,that upon activating the apparatus or changing the demand on theapparatus (e.g., flow rate or pressure), there is a lag time of onlyseveral tenths seconds for sensing the temperature of gas and adjustingthe heating element to achieve the proper gas temperature. Such a faststart-up time is extremely beneficial.

Referring to FIG. 3, the heating element 134 is shown in more detail.The heating element 134 is an electrically resistive wire that isdisposed in the housing 128 in a concentrical coil configuration havinga predetermined number of turns, such as 6-8 turns. Alternatively, asecond heating element 134′ is provided that is arranged with respect tothe heating element 134 such that its coils are offset from those of thefirst heating element, relative to the direction of gas flow through thechamber. If two or more heating elements are employed, they arepreferably spaced from each other in the chamber of the heater/hydratorby approximately 3-4 mm. The first and second heating elements 134 and134′ can be coiled in opposite directions relative to each other. Thisarrangement allows for maximum contact of the gas flowing through thechamber with a heating element. Other non-coiled configurations of theheating element 134 are also suitable.

Turning to FIG. 4, another feature of the heater/hydrator 120 isillustrated. At the inlet and/or outlet of the housing 122, flutedsurfaces 123 may be provided to facilitate complete dispersion of gas asit is supplied to the heater/hydrator 120. This improves the fluiddynamics of the gas flow through the chamber 128 to ensure that the gasis uniformly heated and humidified as it flows through the chamber 128.

Referring to FIG. 5, the control module 140 will be described in detail.The control module 140 contains monitoring circuitry and controlcircuitry for the apparatus 100, and comprises a voltage regulator 141,a microcontroller 142, an A/D converter 143, a dual operationalamplifier (hereinafter “op-amp”) module 144, and a timer/divider 145.The monitoring circuit portion of the control module 140 consists of thecombination of the microcontroller 142 and timer/divider 145. Thecontrol circuit portion of the control module 140 consists of themicrocontroller 142, A/D converter 143 and op-amp module 144. Themonitoring circuit monitors the relative humidity of gas exiting thechamber based on a signal generated by the timer/divider 145. Thecontrol circuit monitors the temperature of the gas exiting the chamberand in response, controls electrical power to the heating element toregulate the temperature of the gas to a predetermined temperature.While the temperature of the gas exiting the chamber is activelycontrolled, the relative humidity of the gas in the chamber is notactively controlled; rather it is monitored and an alert is generatedwhen it drops below a predetermined threshold so that appropriate actioncan be taken, such as replenishing the heater/hydrator with liquid.

FIG. 5 shows that several components are preferably located within theelectrical housing 210 (FIG. 1), whereas other components are locatedwithin the housing of the heater/hydrator 120 (FIG. 2). In particular,the timer/divider 145 and the associated resistors R4 and R5, arepreferably located inside the housing 122 of the heater/hydrator 120,together with the humidity sensor 138 in a circuit package that includesthe humidity sensor 138 exposed on one or more surfaces thereof. Morespecifically, the timer/divider 145 is co-located with humidity sensor138. This configuration minimizes timing error by stray wiringinductance and capacitance (sensor kept close to active circuits oftimer/divider 145). In addition, by co-locating the timer/divider 145and humidity sensor 138, the need for interconnecting wires iseliminated, thereby avoiding undesirable signal radiation.

The voltage regulator 141 receives as input the DC output of the AC-DCconverter 180 (FIG. 1), such as for example, 9V DC, that is suitable foruse by the analog components of the control module. The voltageregulator 141 regulates this voltage to generate a lower voltage, suchas 5V DC, for use by the digital components of the control module. Thecapacitor C1 at the output of the voltage regulator 141 serves to filterout any AC components, as is well known in the art. Alternatively, asuitable DC voltage is provided by a battery or photovoltaic sourceshown at reference numeral 149.

The microcontroller 142 is a PIC16C84 integrated circuit microcontrollerthat controls system operation. A ceramic resonator 146 (4 MHz) isprovided to supply a raw clock signal to pins 15 and 16 of themicrocontroller 142, which uses it to generate a clock signal for thesignal processing functions explained hereinafter.

The op-amp 144 module is coupled (by wire 176) to the temperature sensor136 (thermistor) mounted in the housing of the heater/hydrator. Theop-amp module 144 is, for example, a LTC1013 dual low-input-offsetvoltage operational amplifier integrated circuit that includes twoop-amps, referred to hereinafter as op-amp A and op-amp B. Thenon-inverting input of the op-amp A of the op-amp module 144 is pin 3,and pin 2 is the inverting input. The output of op-amp A is pin 1.Op-amp A of the op-amp module 144 is used to buffer the output voltageof the voltage divider formed by resistors R1 and R2. The bufferedoutput voltage, referred to as Vx in FIG. 5, is applied to op-amp B inthe op-amp module 144. Op-amp B is configured as anon-inverting-with-offset amplifier with a gain of 21.5, and alsoreceives as input the output of the temperature sensor 136, adjusted byresistor R3, shown as voltage Vy in the diagram. The output voltage ofop-amp B is at pin 7, referred to as Vo in FIG. 5. The output voltage Vois equal to 21.5 Vy−20.5 Vx, which is inversely proportional to the gastemperature in the housing of the heater/dehydrator. The output voltageVo ranges between 0-5V DC, depending on the temperature of the gas inthe chamber.

The A/D converter 143 is an ADC 0831 integrated circuitanalog-to-digital converter that receives as input at pin 2, the outputVo of the op-amp module 144. The A/D converter 143 generates a multi-bitdigital word, consisting of 8 bits, for example, that represents theoutput voltage Vo, and is supplied as output at pin 6, which in turn iscoupled to I/O pin 8 of the microcontroller 142. The microcontroller 142commands the A/D converter 143 to output the digital word by issuing acontrol signal on I/O pin 10 which is coupled to the chip select pin 1of the A/D converter 143. Moreover, the microcontroller 142 controls therate at which the A/D converter 143 outputs the digital word bysupplying a sequence of pulses on pin 9 applied to clock input pin 7 ofthe A/D converter 143. The “unbalanced bridge” values of resistors R1,R2 and R3 are chosen to produce a 0-5V DC output over gas temperaturesfrom approximately 20° C. to approximately 45° C. Since the bridge andthe reference for the A/D converter 143 are provided by the same 5V DCsource, error due to any reference voltage shift is eliminated.

The timer/divider 145 is, for example, a MC14541 precision timer/dividerintegrated circuit. The humidity sensor 138 is connected to pin 2 and toresistors R4 and R5 as shown. In response to an enable signal output bythe microcontroller 142 on pin 12 that is coupled to timer/divider pin6, the timer/divider 145 generates an output signal that oscillates at arate determined by the value of the resistor R4, the capacitance of thehumidity sensor 138 (which varies according to the relative humidity ofthe gas inside the heater/hydrator housing) and a predetermined dividerconstant. For example, the divider constant is 256. Specifically, theoutput signal of the timer/divider 145 is a square wave oscillatingbetween 0V (“low”) and 5V (“high”) at a frequency of approximately1/[256*2.3*R4 _(t)*C_(t)] Hz, where R4 _(t) is, for example, 56 k Ohms,and C_(t) is the capacitance at some time (t) of the relative humiditysensor 138 depending on the relative humidity of the gas in the chamber.For example, the humidity sensor manufactured by Phillips Electronics,referred to above, can measure between 10-90% RH (relative humidity),where C_(t) at 43% RH is 122 pF (+/−15%), with a sensitivity of0.4+/−0.5 pF per 1% RH. The output signal of the timer/divider 145appears at pin 8, which is coupled to the I/O pin 13 of themicrocontroller 142. Thus, the timer/divider 145 is essentially anoscillator circuit connected to the humidity sensor that generates anoutput signal with a frequency dependent on a capacitance of thehumidity sensor. Any oscillator circuit that can generate as output asignal whose frequency is dependent on a variable capacitance may besuitable for the timer/divider 145.

The microcontroller 142 computes a measure of the relative humidity ofthe gas inside the heater/hydrator housing by timing or measuring acharacteristic of the output signal of the timer/divider 145.Specifically, microcontroller measures the time duration of one of thephases of the output signal of the timer/divider 142, such as the “high”phase which is approximately ½*[256*2.3*R4 _(t)*C_(t)]. This timeduration is indicative of the relative humidity of the gas in thechamber of the heater/hydrator since the rate of the oscillation of thetimer/divider depends on the capacitance of the humidity sensor 138, asexplained above. For example, for a change in RH of 10-50% and/or50-90%, there is 13% change in the duration of the “high” phase of thetimer/divider output signal. The microcontroller 142 monitors therelative humidity of the gas exiting the chamber in this manner and whenit drops below a predetermined relative humidity threshold (indicated bya corresponding predetermined change in the oscillation rate of thetimer/divider 145), the microcontroller 142 generates a signal on pin17, called a recharge signal, that drives transistor Q3 to activate anaudible alarm device, such as buzzer 147. The buzzer 147 generates anaudible sound which indicates that the relative humidity of the gas inthe heater/hydrator has dropped below the predetermined threshold andthat it is necessary to recharge the heater/hydrator with liquid. Thepredetermined relative humidity threshold corresponds to a minimum levelfor a desirable relative humidity range of the gas exiting theheater/hydrator, and may be 40%, for example. The predetermined relativehumidity threshold is an adjustable or programmable parameter in themicrocontroller 142. Optionally, the microcontroller 142 may generateanother warning signal at the output of pin 7 to illuminate a lightemitting diode (LED) 148A, thereby providing a visual indication of thehumidity dropping below the predetermined relative humidity threshold inthe heater/hydrator, and the need to recharge the heater/hydrator 120with liquid. Further, the microcontroller 142 generates a trouble orwarning signal output at pin 6 to drive LED 148B (of a different colorthan LED 148A, for example) when there is either a “code fault” in themicrocontroller 142 (an extremely unlikely occurrence) or when therelative humidity of the gas in the heater/hydrator is les than acritical relative humidity threshold (lower than the predeterminedrelative humidity threshold), such as 10%. In either case, power to theheating element 134 is terminated in response to the warning signal.

The microcontroller 142 also controls the heating element 134 in orderto regulate the temperature of the gas inside the heater/hydrator.Accordingly, the microcontroller 142 processes the digital word suppliedby the A/D converter 143 to determine the temperature of the gas insidethe heater/hydrator housing. In response, the microcontroller 142generates a heat control signal on the output pin 11 that drivestransistor Q1, which in turn drives the MOSFET power transistor Q2, thatsupplies current to the heating element 134. The temperature of the gasinside the heater/hydrator is regulated by the microcontroller 142 sothat it is within a predetermined temperature range as it exits theheater/hydrator for delivery into the body of a patient. Thepredetermined temperature range that the gas is regulated to isapproximately 35° to 40° C., but preferably is 37° C. As mentioned,above, when the relative humidity inside the heater/hydrator falls belowa critical threshold as determined by the monitoring circuit portion ofthe control module 140, the control circuit portion in responseterminates power to the heating element 134 to prevent the delivery ofwarm gas that is extremely dry.

The circuitry for monitoring the relative humidity of the gas can beembodied by other circuitry well known in the art. In addition, whilethe control module 140 has been described as having a singlemicrocontroller 142 for monitoring signals representing temperature andrelative humidity of the gas exiting the chamber, and for controllingthe heating element to control the temperature of the gas, it should beunderstood that two or more microcontrollers could be used dedicated tothe individual functions. In addition, the functions of themicrocontroller 142 could be achieved by other circuits, such as anapplication specific integrated circuit (ASIC), digital logic circuits,a microprocessor, or a digital signal processor.

The volume of gas that can be conditioned with a full supply of liquidin the heater/hydrator depends on the flow rate and pressure used duringa procedure. Moreover, the apparatus may be designed to accommodatedifferent anticipated needs for particular procedures. As an example,the chamber of the heater/hydrator is designed to hold 8 to 10 cc ofliquid that can humidify 180 liters of gas at a relative humidity levelof 80% or more. The microcontroller 142 is programmable to issue therecharge signal when the humidity of the gas drops below thepredetermined relativity humidity threshold, independent of the flowrate or pressure of the insufflation gas supply. Preferably, thepredetermined relativity humidity threshold is set so that brief periodsof high pressure or high flow rate do not cause this threshold to betriggered, because the humidity level will return togreater-than-threshold levels shortly after the high pressure/flow rateperiods ends.

With reference to FIGS. 1 and 2, the setup and operation of theapparatus 100 will be described. The AC/DC converter 180 is plugged intoan 110V AC power source, such as a wall outlet or a power strip. Thecontrol module 140 is connected to the AC/DC converter 180.Alternatively, the apparatus 100 may be powered by a battery orphotovoltaic source. The heater/hydrator tubing set is then installed byattaching one end of the tube segment 160 to the outlet of the insulator10 by the Luer lock 166. The tube segments 160, 162 and 164 may bepre-attached to the filter 110 and the heater/hydrator 120 forcommercial distribution of the apparatus 100. The cable 170 is installedinto the electrical housing 210 of control module 140 by the connector172. The heater/hydrator 120 is charged with a supply of liquid by thesyringe 200. For example, 8 cc of liquid, such as sterile water, isdrawn into the syringe 200. The syringe 200 is then inserted into thecharging port 190 so that a needle or cannula of the syringe 200penetrates the resealable member 194 (FIG. 2) and the liquid is injectedinto the heater/hydrator 120 to be absorbed by the liquid-retaininglayers. The syringe 200 is then removed from the charging port 190, andthe charging port 190 seals itself. The free end of the tube segment 164is attached to a gas delivery device by the Luer lock 168 or otherappropriate connector. Alternatively, the heater/hydrator 120 may bepre-charged with liquid, thus not requiring a charge prior to operation.

Once the insulator 10 is activated, it receives gas from a gas supplycylinder and regulates the pressure and flow rate of the gas, both ofwhich can be adjusted by the operator. The pressure and volumetric flowrate of the gas, both of which can be adjusted by the operator. Thepressure and volumetric flow rate are controlled by adjusting controls(not shown) on the insufflator 10. Insufflator gas then flows throughthe tube segment 160 into the optional filter 110 where it is filtered,and then through tube segment 162 into the heater/hydrator 120. In theheater/hydrator 120, gas comes into contact with electrical heatingelement 134 and the humidifying liquid-retaining layer(s) 130-132 whichare positioned within the flow path of the gas, as shown in FIG. 2. Inchamber 128, insufflator gas is simultaneously heated and humidified tothe proper physiological range by regulation of the heating element 134and liquid content of the liquid-retaining layers 130-132 such that thetemperature of gas exiting chamber 128 is within a preselectedphysiological temperature range (preferably 35° to 40° C., though anydesired temperature range can be preselected), and within a preselectedrange of relative humidity (preferably above 40% relative humidity, suchas in the range of 80-95% relative humidity). If the apparatus isoperated with the heater/hydrator 120 not charged with liquid eitherbecause the user forgot to manually charge it before initiatingoperation, or the apparatus was sold without a pre-charge of liquid(i.e., in a dry state), the relative humidity of the gas in the chamberof the heater/hydrator 120 will be detected to be below thepredetermined threshold and the alarm will be activated, alerting theuser that the heater/hydrator 120 requires charging of liquid. Theapparatus will automatically issue an alarm to alert a user to the needfor charging the heater/hydrator 120 with liquid, thereby avoidingfurther delivery of unhydrated gas into a patient.

With further reference to FIG. 5, the control module 140 monitors therelative humidity of the gas exiting the chamber and further regulatesthe temperature of the gas in the chamber 128. In particular, themicrocontroller 142 generates a recharge signal when the relativehumidity of the gas in the chamber drops below the predeterminedrelative humidity threshold, indicating that the liquid supply in theheater/hydrator 120 requires replenishing. An audible alarm is issued bythe buzzer 147 and/or a visual alarm is issued by LED 148A to warn themedical attendant or user that the heater/hydrator 120 requiresrecharging. Preferably, the microcontroller 142 continues the alarmuntil the humidity in the chamber returns to a level above thepredetermined relative humidity threshold, which will occur when theheater/hydrator 120 is recharged with liquid. Moreover, themicrocontroller 142 will issue a second alarm, such as by energizing LED148B, when the relative humidity level of gas in the heater/hydrator 120drops below the critical relative humidity threshold, at which pointelectrical power to the heating element 134 is terminated. In addition,the microcontroller 142 controls the temperature of the gas bycontrolling electrical power supplied to the heating element 134.

The apparatus and method according to the present invention provideseveral advantages over similar devices heretofore known, includingthose disclosed in commonly assigned U.S. Pat. No. 5,411,474 to Ott, etal.

In particular, the apparatus of the present invention provides forcontrol of the temperature and monitoring of the humidification of thegas, and of particular importance, generates an audible or visual alarmindicating that the heater/hydrator requires recharging of liquid tosustain and provide timed re-supply of liquid in order to maintain aflow of heated/hydrated gas. The alarm is maintained until theheater/hydrator is recharged and the humidity of the gas returns to apredetermined level. In addition, the apparatus disclosed herein iseasily installed and prepared for use with a minimal amount of lines andtubes. The rechargeable feature of the heater/hydrator eliminates theneed for an additional liquid supply tube connected to theheater/hydrator. If needed, the heater/hydrator may be recharged withliquid several times during a procedure.

In addition, the power supply for the apparatus is derived from astandard AC wall outlet or power strip. Power strips are often providedon medical carts already used in the operating room environment. Byusing a power supply derived from a (normally) uninterrupted AC source,as opposed to the finite amount of power that can be supplied by abattery, accommodating surgical procedures that last longer thananticipated is not a concern. The control circuitry for the apparatus ispreferably contained in an electrical housing that is relatively movablewith respect to the remainder of the apparatus, and therefore can beplaced in a non-interfering position in the operating room. For example,the electrical housing of the control module can be attached by tape orVelcro to the side of the insufflator or other stable structure in theoperating room, and not encumber the remainder of the apparatus ofaffect parameter settings of the insufflator.

The method and apparatus of this invention can be utilized for manymedical procedures requiring the provision of heated and humidified gas.The optional filtration may also be utilized according to the sterilityof gas required for the procedure. The gas is chosen according to theprocedure to be performed and can be any medically useful gas, such ascarbon dioxide, oxygen, nitrous oxide, argon, helium, nitrogen and roomair and other inert gases. Preferable gases for endoscopy are carbondioxide and nitrous oxide. A combination of the above gases can also beused, i.e., 100% of a single gas need not be used. The procedure ispreferably endoscopy such as laparoscopy, colonoscopy, gastroscopy,bronchoscopy, and thorascoscopy. However, it may also be utilized forproviding heated and humidified oxygen or any anesthetic gases orcombination of gases for breathing, for example, or to administeranesthesia or breathing therapy. In particular, the compact size of theapparatus make the invention portable and thus suitable for usesrequiring portability. The gas delivery device that provides the directcontact to the patient should be selected according to the medicalprocedure to be performed as known to those skilled in the art. The gasthat is conditioned by the apparatus may be pressure controlled,volumetrically controlled or both.

Throughout this application, various patents publications arereferenced. The disclosures of these publications in their entiretiesare hereby incorporated by reference into this application in order tomore fully describe the state of the art to which this inventionpertains.

Although the present process has been described with reference tospecific details of certain embodiments thereof, it is not intended thatsuch details should be regarded as limitations upon the scope of theinvention except as and to the extent that they are included in theaccompanying claims.

1. A method of treating gas for endoscopic surgery comprising the steps of: a) directing a gas from a laparoscopic insufflator into a chamber; b) humidifying the gas within the chamber with a volume of liquid; c) sensing the humidity of the gas within the chamber; d) detecting when the humidity of the gas in the chamber is below a predetermined humidity level; and f) generating an audio or visual recharge signal when the humidity of the gas in the chamber is below the predetermined humidity level.
 2. The method of claim 1, further comprising replenishing the chamber with liquid in response to the recharge signal.
 3. The method of claim 2, wherein detecting comprises determining when the relative humidity of the gas in the chamber drops below the predetermined humidity level.
 4. The method of claim 2, and further comprising generating an alarm when the humidity of the gas in the chamber is below the predetermined humidity level.
 5. The method of claim 4, and further comprising recharging the chamber with liquid in response to the alarm.
 6. The method of claim 4, wherein the alarm is continued until the humidity of the gas in the chamber is above the predetermined humidity level.
 7. The method of claim 1, and further comprising generating an audio and/or visible alarm when it is determined that the humidity of the gas in the chamber drops below the predetermined humidity level.
 8. The method of claim 1, and further comprising heating the gas within the chamber with a heating element, sensing the temperature of the gas within the chamber, and controlling electrical power to the heating element in response to the sensing of the temperature.
 9. A method of treating gas for endoscopic surgery comprising the steps of: a) directing a gas from a laparoscopic insufflator into a chamber; b) humidifying the gas within the chamber with a volume of liquid; c) sensing the humidity of the gas within the chamber; d) detecting when the humidity of the gas in the chamber is below a predetermined humidity level; and f) generating a recharge signal when the humidity of the gas in the chamber is below the predetermined humidity level, and further comprising heating the gas within the chamber, with a heating element, sensing the temperature of the gas within the chamber, and controlling electrical power to the heating element in response to the sensing of the temperature and terminating electrical power to the heating element when the humidity of the gas in the chamber is below the predetermined humidity level.
 10. The method of claim 8, wherein the humidifying and heating are performed on the gas substantially simultaneously within the chamber.
 11. The method of claim 8, wherein the sensing of humidity and sensing of temperature are performed in the flow path of the gas downstream from the location of the heating and humidifying in the chamber.
 12. The method of claim 1, and further comprising positioning the chamber immediately adjacent the patient.
 13. The method of claim 1, and further comprising filtering the gas prior to humidifying the gas.
 14. The method of claim 1, and further comprising heating the gas within the chamber with a heating element to a temperature between 35 and 40° C., sensing the temperature of the gas; and controlling electrical power to the heating element so as to keep the temperature of the gas within the chamber in the range of 35 to 40° C.
 15. The method of claim 1, further comprising heating the gas within the chamber with a heating element to a physiologic temperature, sensing the temperature of the gas; and controlling electrical power to the heating element so as to keep the temperature of the gas within the chamber at the physiologic temperature.
 16. A method of treating gas for endoscopic surgery comprising the steps of: a) directing a gas from a laparoscopic insufflator into a chamber; b) heating and humidifying the gas within the chamber; c) treating the gas by admixing at least one agent, other than air or water, with the gas; d) sensing at least one of the temperature or humidity of the gas within the chamber; and e) delivering the treated gas with the admixed agent to the interior of the patient.
 17. The method defined in claim 16, further comprising generating a recharge signal when the humidity of the gas is below a predetermined desired level.
 18. The method defined in claim 17, wherein the at least one agent is a liquid phase agent.
 19. The method defined in claim 17, wherein the at least one agent is a solid phase agent.
 20. An apparatus for treating gas prior to the use of the gas in endoscopic surgery, the gas being received into the apparatus from a laparoscopic insufflator, and the gas exiting the apparatus being in flow communication with a means for delivering the gas to the interior of the patient, the apparatus comprising: a) a housing defining a chamber having an entry port and an exit port, the exit port being in flow communication with the means for delivering the gas to the interior of the patient, and the inlet being in flow communication b) a source of humidity disposed within the chamber; c) a humidity sensor disposed within the chamber; d) monitoring means connected to the humidity sensor for detecting when the relative humidity of the gas in the chamber is below a predetermined relative humidity threshold, and e) a means for delivering the gas to the interior of the patient connected to the exit pod of the chamber.
 21. An apparatus for treating gas prior to the use of the gas in endoscopic surgery, comprising: a) a housing defining a chamber having an entry port and an exit port; b) a laparoscopic insufflator connected to the inlet of the chamber; c) a means for delivering gas to a patient connected to the outlet of the chamber; d) a source of humidity disposed within the chamber; e) a humidity sensor disposed within the chamber; and f) electronic circuitry connected to the humidity sensor to determine when the relative humidity of the gas in the chamber falls below a critical relative humidity threshold.
 22. The apparatus defined in claim 21 comprising a heater disposed within the chamber.
 23. The apparatus defined in claim 22, comprising a temperature sensor disposed within the chamber.
 24. The apparatus defined in claim 23 comprising: a) a temperature sensor disposed within the chamber; and b) control circuitry connected to the temperature sensor and to the heater to control electrical power to the heater. 